Monthly Archives: June 2017

Memorial Hermann Health System President and CEO Dr. Benjamin Chu resigned to pursue a role in crafting health and public policy, the health system announced Monday. The resignation was effective immediately. Chuck Stokes, executive vice president and chief operating officer, has taken over as interim CEO.

Chu landed the top office at the Houston-based health system last June, replacing former CEO Dan Wolterman, who retired after about 15 years at the helm. Chu previously served as Oakland, Calif.-based Kaiser Permanente’s group president for Southern California and Georgia and vice president of Kaiser Foundation Hospitals and Health Plan.

Memorial is currently in the credit review process with both Moody’s Investors Service and Standard & Poor’s. Memorial does not expect the transition to lead to any material credit action, executives said. Moody’s declined to comment.

Chu was tasked with better integrating the system’s clinical operations when he joined Memorial Hermann, marking the first time a physician led the organization. At Kaiser, Chu implemented an integrated electronic health record system and population health management tools.

“I have admired Memorial Hermann from afar for many years, and I was incredibly honored to join this prestigious organization,” Chu said in a statement. “It has been a privilege to have led one of the nation’s largest and most successful health systems—one that advocates for improved access to safe, high-quality care.”

Chu continues to be board chair for the Commonwealth Fund in New York and a member of the advisory committee to the director of the Centers for Disease Control and Prevention. Chu most recently served as chair of the American Hospital Association’s board of trustees. He also was president of New York City Health & Hospitals Corp. and was the acting commissioner of health for the New York City Health Department.

“As a physician and longtime public policy advocate, Chu plans to continue his mission to enhance access to high-quality care and improve the overall health of our population,” Memorial Hermann Board Chair Deborah Cannon said in a statement. “With the current state of the healthcare industry, I can think of no better time for a champion like Chu to help lead public policy efforts. We thank him for his service and wish him the very best in his future endeavors. In the interim, we are confident Chuck will fill the role seamlessly.”

Moody’s assigned an A1 rating to Memorial Hermann’s proposed $129 million issue of fixed rate bonds last May, based on its leading market position in the greater Houston area, favorable demographics and a history of strong revenue growth and operating cash flow margins, the report said.

“We’ve received positive bond ratings in the past based on our financial strength and the market’s confidence in our strategic and operational performance. We have a deep and strong management team, and remain in good hands during the CEO transition,” Dennis Laraway, executive vice president and chief financial officer, said in a statement. “Our greater (credit) concerns rest with changing economic conditions in Houston, a result of the prolonged energy recession.”

Memorial Hermann is neck-and-neck with HCA as the market share leader in the Houston region with more than $5 billion in annual revenue.

In an interview last month, Stokes said Memorial Hermann plans to spend $2 billion in 2017, mostly for hospital expansions and upgrades. The system has run short of capacity at its main campus and has been moving into the Houston suburbs to make care convenient and less costly for patients who don’t need to be seen in a tertiary setting, he said.

“Over the past several years, we’ve put our capital in growth, because we had to turn down almost 2,000 admissions last year because of capacity issues,” Stokes said.

In its Katy, Texas, market, Memorial Hermann is adding a new patient tower and medical office building. That follows a similar expansion at its Sugar Land campus a year ago.

Memorial Hermann also is building a new patient tower at its flagship Texas Medical Center, which is set to open in 2019, Stokes said.

HCA, based in Nashville, recently agreed to buy three hospitals in Houston from Dallas-based Tenet Healthcare Corp. The additional hospitals will give HCA 13 in that market and put it on a par with Memorial Hermann, Jefferies & Co. analyst Brian Tanquilut said last month.

AUSTIN, Texas—Paying for certain high-cost drugs based on the patient outcomes they deliver is becoming increasingly necessary in the face of skyrocketing drug costs in the U.S., the CEOs of a health insurance company and a pharmaceutical giant agreed Thursday.

The two industries rarely see eye to eye. Harvard Pilgrim Health Care CEO Eric Schultz and Eli Lilly CEO David Ricks joked Thursday at the 2017 AHIP Institute and Expo in Austin, Texas, that they almost called off their panel discussion for fear of having to sit next to each other. But the two found common ground on value-based agreements.

“We in the health insurance industry have used payment for value, payment for performance, for many years with physicians and hospitals,” Schultz said during the session. “Applying it here makes an awful lot of sense.”

“There couldn’t be a more important concept to embrace,” Ricks said, adding that such deals “open up access and availability of new therapies to the appropriate patient, and deliver better outcomes for the people we’re serving.”

Value-based drug agreements, in which insurers pay for the cost of a drug based on how effective it is, are uncommon, but more deals are popping up as insurers look for ways to get a handle on rising drug costs. Still, regulatory barriers and a healthcare system oriented to paying for care based on volume stand in the way of the deals becoming widespread any time soon.

Harvard Pilgrim is one plan leading in the charge toward such outcomes-based deals. It has struck 12 contracts with pharma companies, including Eli Lilly and Co., who the Boston-based health plan will pay for medicines based on patients’ outcomes or adherence to the medication, Schultz said. National health insurers Aetna and Cigna Corp. have also touted the outcomes-based deals they have reached with drugmakers such as Novartis.

In one of the deals between the two, Harvard Pilgrim pays Eli Lilly a lower price for its Type 2 diabetes drug Trulicity if patients do better on competing diabetes drugs. We’re “putting our money where are mouth is—not just making claims about superiority, but measuring outcomes,” Ricks explained.

The two CEOs see the value-based contracts as one answer to the rising cost of drugs in the United States, which are causing health insurers and employers to raise premiums and shift more costs to the patient.

Harvard Pilgrim sees the deals as a way to improve clinical outcomes and get the right drug to a patient who will respond well, Schultz said.

“Does it save money at this point? It’s very modest, but I do believe there’s an opportunity down the road,” he said.

The U.S. spent $3.2 trillion on healthcare in 2015, nearly $10,000 per person. About 10%, or $325 billion, of that spending came from prescription drugs, according to the CMS’ latest figures. Part of that is being driven by the increasing prices of drugs, which Schultz characterized as a “crisis.”

At the same time, drugmakers are developing groundbreaking therapies that can improve patients’ lives and even cure them from some chronic diseases.

The U.S. is in the midst of a push to pay for healthcare based on value rather than the volume of services delivered. Not only does Medicare reward doctors for good care and ding them for high readmission rates or infections, private insurers have been shifting more risk to providers and holding them accountable for the cost and quality of care. Now half of healthcare systems are getting some or most of their reimbursement from value-based payments, a recent KPMG survey showed.

Value-based drug agreements seem like a natural next step in the evolution. But the deals aren’t easy to administer. It takes time and a lot of resources to capture and analyze an immense amount of data, which health plans need to determine if the drug produced the promised outcome.

“Of course it’s easier to build and have fee-for-service agreements in pharmaceuticals as well as other segments,” Ricks said. But it’s becoming necessary for pharma to strike up value-based deals as health insurers increasingly resist paying for new drugs because of the price tag, he said.

In that case, “The patient doesn’t have any therapy available; the health plan isn’t achieving its goal, which is also to advance patient care; and the innovator is stuck—we don’t have a market for our products.”

Several regulatory barriers are keeping companies from creating more outcomes-based contracts. For instance, some discounts negotiated under such contracts could run afoul of federal anti-kickback statutes, he said. And Food and Drug Administration rules surrounding communication between a payer and drugmaker before a drug is approved make striking the deals difficult.

A robust FDA pipeline of drugs, especially cancer drugs, will present new opportunities for plans and manufacturers to strike outcomes-based deals because the new drugs have little data to establish their value, Schultz said.

“Right now, of the 12 contracts that we have, we have them because . . . a new drug was coming out, so there was an incentive for a pharma company to sit down with us and negotiate,” he said. “The real challenge is to believe this is the right thing to do and sit down and negotiate a value-based contract even though there may not be a competing drug or biologic coming out.”

Schultz also pushed for greater transparency in how drugmakers set their prices. Health insurers, he said, are held accountable by regulators and employers to outline deductibles, premiums—all the components of a health plan’s price. Holding drug akers to the same standard would put “economic pressure on the pharmaceutical companies when they’re sitting in their pricing strategy rooms and saying, ‘What should we set this price at?’ ” he said. “We don’t have that today.”